Special therapies ("Heilmittel") and medical aids ("Hilfsmittel") in Germany

In the German health care system, Heilmittel are defined as medical treatments that

• do not involve the use of medication and are applied to the outside of the body, and
• are paid for by statutory health insurers.

These therapies can be prescribed by a doctor in order to treat an illness, to prevent it from getting worse, or to relieve its symptoms. They may also be used to prevent illnesses from developing in the first place and, for instance, to help prevent developmental disorders in children or dependence on nursing care in elderly people.

The following treatments can be prescribed as Heilmittel by doctors in Germany:

• Occupational therapy (Ergotherapie)
• Physical therapy/physiotherapy (Physiotherapie)
• Speech therapy (Logopädie – including voice and swallowing therapy)
• Podiatry (Podologie)
• Nutritional therapy (Ernährungstherapie)

Only certified healthcare professionals who have the proper training are allowed to offer these Heilmittel therapies. They mainly include:

• Occupational therapists
• Physical therapists (physiotherapists)
• Masseurs and hydrotherapists (healthcare professionals who use water to treat medical problems)
• Speech therapists
• Podiatrists (foot care specialists)
• Nutritional therapists

If your doctor thinks that one of these Heilmittel treatments will help, they will give you a prescription. The prescription states how many treatment sessions the doctor has prescribed and how often they should take place (which depends on the illness and the type of treatment). Once you have a prescription, you can make appointments with a suitable healthcare professional. If the symptoms still haven’t gone away after the last appointment, your doctor can prescribe more sessions.

Heilmittel treatments are often part of a treatment plan during a hospital stay. They might be used for rehabilitation purposes, for example. In these cases, statutory health insurers cover all the costs of this treatment. But if you’re prescribed a Heilmittel treatment in an outpatient setting, you have to pay part of the costs yourself: 10 euros plus 10% of the treatment costs per prescription. You don’t have to pay if the prescription is for a child or teenager, though, because statutory health insurers always pay for Heilmittel treatments up until the age of 18.

Normally, the treatment has to start within 28 days of the date on the prescription. Otherwise, the prescription becomes invalid. If the treatment is needed urgently, it must start within 14 days of the date on the prescription. The doctor has to specify this on the prescription. The prescription also becomes invalid if the treatment is stopped for more than 14 days without providing a reason.

The healthcare professionals might also offer treatments that you have to pay for yourself.

In the German health care system, Hilfsmittel are defined as products that are mainly used to help people cope better in daily life if they have an illness, a disability or need nursing care. These aids include glasses, hearing aids, artificial limbs, wheelchairs, nursing beds, bath seats and disposable supplies like syringes and bandages. Hilfsmittel aids can help to

• treat illnesses,
• prevent or compensate for disabilities and conditions that make nursing care necessary,
• prevent developmental disorders in children (using a hearing aid, for example),
• provide nursing care and
• support people who need nursing care.

The term “Hilfsmittel” covers a large variety of products for a range of very different health problems. The website of the German National Association of Statutory Health Insurance Funds ("GKV-Spitzenverband") has a list of Hilfsmittel medical aids that health insurers will pay for in full or in part.

These aids can be prescribed by your doctor. Once you’ve got the prescription, you can take it to a supplier of that kind of medical aid. Depending on what you need, suppliers include:

• Opticians, e.g. for glasses
• Audiologists (Hörgeräteakustiker), e.g. for hearing aids
• Medical supply stores (Sanitätshaus), e.g. for elastic bandages, inhalers, walking aids and bathing aids
• Orthopedic technicians, e.g. for artificial limbs and braces
• Podiatrists (medizinische Fußpflege), mainly for foot and toe pads
• Orthopedic footwear specialists, e.g. for insoles and made-to-measure orthopedic shoes

If you don’t need these medical aids for very long, you can sometimes borrow them from a health insurer or supplier. For instance, if you’re recovering from an acute illness and need a wheelchair for a while, you can borrow it and return it later.

Some medical aids, like glasses or insoles, have to be adjusted especially for you. For others, you need to attend training to learn how to use them properly. Examples include ventilators and breathing masks designed to make sure heavy snorers don’t stop breathing when they’re asleep (sleep apnea). In some of these cases, the health insurer won’t pay for the medical aid until you’ve done the training.

The question of who pays for these aids depends on what they’ve been prescribed for. For instance, is the aim to relieve symptoms, support nursing care or make working life easier? Usually, your health insurer or nursing care insurer (Pflegeversicherung) pays – but it could also be your pension fund (Rentenkasse), accident insurance provider (Unfallversicherung), the employment agency (Arbeitsagentur) or the social welfare office (Sozialamt).

If your health insurer covers these costs, you have to pay a prescription fee of 10 euros per prescription plus a co-payment of 10% of the price of the Hilfsmittel aid. The co-payment will be at least 5 euros and at most 10 euros. For example, if the medical aid costs 70 euros, you’ll have to pay 17 euros (10 euros for the prescription plus 7 euros for the co-payment). The co-payment isn’t allowed to be more than the price of the medical aid, though. If the aid costs less than 5 euros, you will have to pay for it yourself. If the prescription is for disposable supplies such as bandages or syringes, the co-payment is limited to 10 euros per month. If you’re prescribed a Hilfsmittel medical aid, you must buy or order it within 28 days of the prescription date. After that, the prescription is no longer valid. As with Heilmittel treatments, children and teenagers under the age of 18 don’t have to pay anything for Hilfsmittel aids. Statutory health insurers cover all of their costs.

If you need nursing care and are prescribed a Hilfsmittel aid, your nursing care insurer (Pflegeversicherung) will cover the costs. You then have to pay 10% of the price yourself, but no more than 25 euros. Where Hilfsmittel aids are needed both for nursing care and treatment, the costs are sometimes divided between the health insurer and the nursing care insurer.

These rules may be different if the costs are covered by pension funds, accident insurance providers, the employment agency or the social welfare office.